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Chronic pain treatment

One of the most serious problems in modern medicine is the under-treatment of patients in chronic pain.  More than 30 million patients suffer from chronic pain, and seven million of them cannot relieve their pain without opioids (narcotics), but only 4,000 doctors in the country are willing to prescribe them, according to the National Chronic Pain Outreach Association.  A New England Journal of Medicine editorial stated that 56 percent of cancer outpatients and 82 percent of AIDS outpatients were undertreated for pain, as were 50 percent of hospitalized patients with a range of conditions.

Today's massive denial of pain medication is a consequence of the social, regulatory and law enforcement climate created by the War on Drugs. Doctors can suffer loss of license or even incarceration, when the inevitable mistake of providing medicine to a dishonest patient who may be misusing or diverting medication occurs.  The climate has led to a situation in which most physicians are incorrectly trained in pain management and under- or non-treatment of pain is the norm.  Doctors who treat pain correctly typically must exceed the usual prescribed dosages, and in so doing draw the scrutiny of state medical boards and the U.S. Drug Enforcement Administration (DEA).  The DEA demands that doctors and pharmacies regularly provide them with records of every prescription for controlled substances that is written or filled.

As Virginia physician William Hurwitz, whose case was featured on Sixty Minutes, explains, "The quasi-criminal liability imposed on physicians distorts clinical information and medical judgment, impedes the development of clinical expertise, undermines the ethical commitments necessary to medical practice, and leads to the abandonment, wasted lives, and deaths of patients with intractable pain.  Holding physicians liable for the misbehavior or dishonesty of their patients turns physicians into policemen and is, in principle, incompatible with effective medical care."  Frank McNeil, a family practitioner in Knoxville, Tennessee, explains, "As doctors, we believe in people, but the government expects each of us to be an FBI unit. We're supposed to trust no one."

The fate of pain patients in the "police state of medicine" is grim.  Day after day of constant torment drives many to depression or even suicide. Many patients receive enough medicine to provide relief for four hours out of the day, and have to decide which 20 hours of the day they will spend in extreme pain.  Frightened doctors sometimes "fire" patients, cutting them off from pain meds suddenly, thereby putting them at risk for shock or withdrawal.  And those patients receiving adequate prescriptions live in fear that their doctors could be put out of business by the government or frightened into cutting them off.  Former addicts as well as former prisoners are in the worst situation of all, being automatically suspect -- but pain patients from these backgrounds need and deserve proper treatment nonetheless.

 

National organizations:

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Study Shows that Pain Went Up Sharply Among Oregon's Dying in Late 1997 (Oct. 16, 1998)

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Deadly Morals: The DEA is Busting Doctors and Patients are Dying in Pain
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The Police State of Medicine from DRCNet's online drug library

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